1790872513 NPI number — MRS. CONSTANCE W PULLEN LCSW C

Table of content: MRS. CONSTANCE W PULLEN LCSW C (NPI 1790872513)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790872513 NPI number — MRS. CONSTANCE W PULLEN LCSW C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PULLEN
Provider First Name:
CONSTANCE
Provider Middle Name:
W
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790872513
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25800 AVONIA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROYAL OAK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21662-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-822-6501
Provider Business Mailing Address Fax Number:
410-334-6960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25800 AVONIA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYAL OAK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21662-1417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-822-6501
Provider Business Practice Location Address Fax Number:
410-334-6960
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  06299 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 06299 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6293528 . This is a "UNITED BEHAVIOR HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0007 . This is a "CAREFIRST FEDERAL PIN" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 259147000 . This is a "MAGELLAN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 352441000 . This is a "MAGELLAN PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 100067559001 . This is a "AMERICAN PSYCH SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 52742702 . This is a "CAREFIRST BCBS PIN" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: LM49EA . This is a "CAREFIRST BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2101679 . This is a "UNITEDHEALTHCARE MAMSI PI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 609550002 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 609550005 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 517251 . This is a "UHC MAMSI GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 723622 . This is a "NCPPO PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: R968 . This is a "CAREFIRST FEDERAL GROUP" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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